Clip deployment tool and associated methods

ABSTRACT

A laparoscopic device comprising: (a) a housing operatively coupled to a first control and a second control; (b) an end effector operatively coupled to the first control, the end effector comprising a first component and a second component selectively repositionable with respect to one another within an X-Y plane, the end effector also including a third component selectively repositionable with respect to the second component within an Y-Z plane; (c) a laparoscopic conduit extending between the housing and the end effector; and, (d) an occlusion clip deployment device operatively coupled to the end effector and the second control.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a continuation of, and claims priority under 35U.S.C. § 120 to, U.S. Nonprovisional patent application Ser. No.13/355,169, filed Jan. 20, 2012, the disclosure of which is incorporatedherein by reference.

FIELD OF THE INVENTION

The present disclosure relates to deployment of an occlusion clip and,more specifically, to devices and methods utilized to deploy anocclusion clip using a handheld device.

INTRODUCTION TO THE INVENTION

The exemplary embodiments disclosed herein include one or more active orpassive repositioning mechanisms. As will be discussed in more detailhereafter, an active repositioning mechanism provides for infiniteadjustments as the user is physically operating a control to directlymanipulate the repositioning of an end effector or a device mounted toan end effector. In contrast, a passive repositioning mechanism can bethought of as acting similar to a light switch, either off or on. Inthis manner, the passive repositioning mechanism either allows ordisallows repositioning of the end effector or a device mounted to theend effector, but is not responsible for actively manipulating theaspect ultimately repositioned. Put another way, the passiverepositioning system allows for free movement of the end effector or adevice mounted to the end effector within the relevant range of motionwhen the mechanism is in the “on” position, but locks movement when themechanism is in the “off” position. In exemplary form, a laparoscopicdevice may incorporate passive repositioning mechanisms to controlmovements in different directions, such as pitch and yaw.

It is a first aspect of the present invention to provide a laparoscopicdevice comprising: (a) a housing operatively coupled to a first controland a second control; (b) an end effector operatively coupled to thefirst control, the end effector comprising a first component and asecond component selectively repositionable with respect to one anotherwithin an X-Y plane, the end effector also including a third componentselectively repositionable with respect to the second component withinan Y-Z plane; (c) a laparoscopic conduit extending between the housingand the end effector; and, (d) an occlusion clip deployment deviceoperatively coupled to the end effector and the second control.

In a more detailed embodiment of the first aspect, the handle housing isoperatively coupled to a third control, the third control is operativelycoupled to the occlusion clip and the occlusion clip deployment device,and the third control controls disengagement of the occlusion clip fromthe occlusion clip deployment device. In yet another more detailedembodiment, the first control includes a first passive constraint and asecond passive constraint, the first passive constraint in an unlockedposition allows free motion between the first component and the secondcomponent within the X-Y plane, the first passive constraint in a lockedposition retards free motion between the first component and the secondcomponent within the X-Y plane, the second passive constraint in anunlocked position allows free motion between the second component andthe third component within the Y-Z plane, and the second passiveconstraint in a locked position retards free motion between the secondcomponent and the third component within the Y-Z plane. In a furtherdetailed embodiment, the first passive constraint includes at least oneconnection wire in tension that is operatively coupled to the secondcomponent and to the housing, and the second passive constraint includesat least one connection wire in tension that is operatively coupled tothe third component and to the housing. In still a further detailedembodiment, the first control includes a repositionable buttonselectively coupled to a first reel and a second reel, where the buttonis repositionable between a locked and an unlocked position, where thelocked position retards rotation of the first reel and the second reel,and where the unlocked position allows rotation of the first reel andthe second reel, the first reel is operatively coupled to a firstconnection line operatively coupled to the first component, the secondreel is operatively coupled to a second connection line operativelycoupled to the second component, and wherein the first reel isindependently repositionable with respect to the second reel.

In yet another more detailed embodiment of the first aspect, the secondcontrol includes a lever operatively coupled and selectivelyrepositionable with respect to the housing, the lever being operativelycoupled to a first connection line operatively coupled to the occlusionclip deployment device so that movement of the lever is operative toreposition at least a portion of the occlusion clip deployment device,the lever is repositionable between a locked and an unlocked position,the unlocked position allows the lever to be repositioned, and thelocked position retards the lever from being repositioned. In stillanother more detailed embodiment, the laparoscopic device furtherincludes a third control operatively coupled to the housing, wherein thethird control is operatively coupled to a first connection lineoperatively coupled to the occlusion clip deployment device so thatmovement of the third control is operative to reposition at least aportion first connection line with respect to the occlusion clipdeployment device. In a further detailed embodiment, the third controlincludes a plug detachable from the housing, the plug is repositionablefrom an attached position coupled to the housing to a detached positiondecoupled from the housing, and repositioning the plug from the attachedposition to the detached position causes more of the first connectionline to be drawn into the housing and further away from the occlusionclip deployment device. In still a further detailed embodiment, thelaparoscopic device further includes an occlusion clip operativelycoupled to the clip deployment device using the first connection line.In a more detailed embodiment, the end effector includes a roboticgrasping feature to facilitate grasping and repositioning of the endeffector by a robotic grasper.

It is a second aspect of the present invention to provide a laparoscopicdevice comprising: (a) a housing operatively coupled to a first control;(b) an end effector operatively coupled to the first control, the endeffector comprising a clevis selectively repositionable with respect toa dual pivot joint within an X-Y plane, the dual pivot joint selectivelyrepositionable with respect to a yoke within an Y-Z plane; (c) alaparoscopic conduit extending between the housing and the end effector.

In a more detailed embodiment of the second aspect, the first controlincludes a first line and a second line extending along the laparoscopicconduit concurrently coupled to the dual pivot joint, the first lineimpacting movement of the dual pivot joint with respect to the clevis ina first direction within the X-Y plane, the second line impactingmovement of the dual pivot joint with respect to the clevis in a seconddirection, generally opposite the first direction, within the X-Y plane,and the first control includes a third line and a fourth line extendingalong the laparoscopic conduit concurrently coupled to the yoke, thethird line impacting movement of the yoke with respect to the dual pivotjoint in a third direction within the Y-Z plane, the fourth lineimpacting movement of the yoke with respect to the dual pivot joint in afourth direction, generally opposite the third direction, within the Y-Zplane. In yet another more detailed embodiment, the first line and thesecond line are coupled to a first actuator mounted to the housing, thefirst actuator is repositionable and operative to reposition the firstline and the second line in order to create movement between the clevisand dual pivot joint, the third line and the fourth line are coupled toa second actuator mounted to the housing, the second actuator isrepositionable and operative to reposition the third line and the fourthline in order to create movement between the yoke and dual pivot joint.In a further detailed embodiment, the first actuator comprises a firstreel upon which at least a portion of the first line and the second lineare wound, the second actuator comprises a second reel upon which atleast a portion of the third line and the fourth line are wound,repositioning of the first reel is operative to distally reposition oneof the first line and the second line, while repositioning of the firstreel is operative to proximally reposition the other of the first lineand the second line, repositioning of the second reel is operative todistally reposition one of the third line and the fourth line, whilerepositioning of the second reel is operative to proximally repositionthe other of the third line and the fourth line.

In yet another more detailed embodiment of the second aspect, the firstcontrol includes a brake that may be selectively applied to the firstactuator and the second actuator to retard movement of the dual pivotjoint with respect to the clevis within the X-Y plane and movement ofthe yoke with respect to the dual pivot joint within the Y-Z plane. Instill another more detailed embodiment, the brake comprises a springbiased button operatively coupled to a series of teeth, the first reelincludes a series of teeth, the second reel includes a series of teeth,and engagement between at least one of the series of teeth operativelycoupled to the spring biased button and at least one of the series ofteeth of the first reel and least one of the series of teeth of thesecond reel is operative to retard movement of the dual pivot joint withrespect to the clevis within the X-Y plane and movement of the yoke withrespect to the dual pivot joint within the Y-Z plane. In a furtherdetailed embodiment, the laparoscopic device further includes anocclusion clip deployment device operatively coupled to the end effectorand to a second control, where the housing is operatively coupled to thesecond control, and the second control includes a clip repositioningline extending along the laparoscopic conduit, the clip repositioningline impacting movement of the occlusion clip deployment device betweena first position and a second position. In still a further detailedembodiment, the second control includes a lever operatively coupled andselectively repositionable with respect to the housing, the lever beingoperatively coupled to the clip repositioning line so that movement ofthe lever is operative to reposition the occlusion clip deploymentdevice, the lever is repositionable between a locked and an unlockedposition, the unlocked position allows the lever to be repositioned, andthe locked position retards the lever from being repositioned. In a moredetailed embodiment, the laparoscopic device further includes adeployment control operatively coupled to the housing, the deploymentcontrol including a deployment line extending along the laparoscopicconduit and concurrently mounted to a deployment plug removably fastenedto the housing. In a more detailed embodiment, the laparoscopic devicefurther includes an occlusion clip operatively coupled to the occlusionclip deployment device using the deployment line. In another moredetailed embodiment, the occlusion clip includes a first jaw opposing asecond jaw, a first retainer loop at least partially circumscribes thefirst jaw, at least a portion of the occlusion clip deployment device,and at least a portion of the deployment line, a second retainer loop atleast partially circumscribes the second jaw, at least a portion of theocclusion clip deployment device, and at least a portion of thedeployment line. In yet another more detailed embodiment, the endeffector includes a robotic grasping feature to facilitate grasping andrepositioning of the end effector by a robotic grasper.

It is a third aspect of the present invention to provide a laparoscopicdevice comprising: (a) a laparoscopic handle; (b) a laparoscopic conduitoperatively coupled to the laparoscopic handle; (c) a laparoscopic endeffector operatively coupled to the laparoscopic conduit; (d) a passivecontrol allowing repositioning of an end effector with respect to thelaparoscopic conduit within an X-Y plane and a Y-Z plane when thepassive control is disengaged and retarding repositioning of the endeffector with respect to the laparoscopic conduit within the X-Y planeand the Y-Z plane when the passive control is engaged.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is an elevated perspective view of an exemplary laparoscopicdevice in accordance with the instant disclosure.

FIG. 2 is an elevated perspective view of the proximal end of theexemplary laparoscopic device of FIG. 1.

FIG. 3 is an elevated perspective view of the proximal end of theexemplary laparoscopic device of FIG. 2, without the left side housing.

FIG. 4 is a profile view of the proximal end of the exemplarylaparoscopic device of FIG. 2, without the left side housing and withoutsome of the internal components in order to show the axle in a distalportion of a through hole in the repositionable button.

FIG. 5 is an elevated perspective view of a distal portion of theproximal end of the exemplary laparoscopic device of FIG. 2, without theleft side housing and without the clip release wires and the draw wires,and with the pitch and yaw controls in an unlocked position.

FIG. 6 is a profile view of a distal portion of the proximal end of theexemplary laparoscopic device of FIG. 2, without the left side housingand without the clip release wires and the draw wires, and with thepitch and yaw controls in a locked position.

FIG. 7 is a profile view of a distal portion of the proximal end of theexemplary laparoscopic device of FIG. 2, without the left side housingand without the clip release wires and the draw wires, and with thepitch and yaw controls in the unlocked position.

FIG. 8 is a profile view of a distal portion of the proximal end of theexemplary laparoscopic device of FIG. 2, without the left side housing,the clip release wires, the draw wires, and the yaw control.

FIG. 9 is an elevated perspective view of a distal portion of theproximal end of the exemplary laparoscopic device of FIG. 2, without theleft side housing, the clip release wires, the draw wires, and the yawcontrol.

FIG. 10 is an elevated perspective view of a distal portion of theproximal end of the exemplary laparoscopic device of FIG. 2, without theleft side housing, the clip release wires, the draw wires, and thecontrol button.

FIG. 11 is an end view, from the proximal end, of an exemplary clevis ofthe exemplary laparoscopic device of FIG. 1.

FIG. 12 is an end view, from the distal end, of the exemplary clevis ofFIG. 11.

FIG. 13 is a profile view of the exemplary clevis of FIG. 11.

FIG. 14 is an elevated perspective view of the exemplary clevis of FIG.11.

FIG. 15 is an elevated perspective view, from a distal end, of anexemplary dual pivot joint of the exemplary laparoscopic device of FIG.1.

FIG. 16 is a profile view of the exemplary dual pivot joint of FIG. 15.

FIG. 17 is an elevated perspective view, from a proximal end, of theexemplary dual pivot joint of FIG. 15.

FIG. 18 is a top view of the exemplary dual pivot joint of FIG. 15.

FIG. 19 is an end view, from the proximal end, of the exemplary dualpivot joint of FIG. 15.

FIG. 20 is another elevated perspective view, from a distal end, of theexemplary dual pivot joint of FIG. 15.

FIG. 21 is an elevated perspective view, from a proximal end, of anexemplary yoke of the exemplary laparoscopic device of FIG. 1.

FIG. 22 is a top view of the exemplary yoke of FIG. 21.

FIG. 23 is an underneath perspective view, from a lateral side, of theexemplary yoke of FIG. 21.

FIG. 24 is a distal view of the exemplary yoke of FIG. 21.

FIG. 25 is a bottom view of the exemplary yoke of FIG. 21.

FIG. 26 is another underneath perspective view, from the oppositelateral side, of the exemplary yoke of FIG. 21.

FIG. 27 is an elevated perspective view, from the proximal end, of theexemplary dual pivot joint and yoke mounted to a clip deployment device,where the view shows the both sets of connection wires, the draw wires,and the clip release wires.

FIG. 28 is an elevated perspective view, from the proximal end, of theexemplary yoke mounted to a clip deployment device, where the view showsone set of connection wires, the draw wires, and the clip release wires.

FIG. 29 is an elevated perspective view, from the proximal end, of theexemplary clevis, dual pivot joint, and yoke mounted to a clipdeployment device and an occlusion clip, where the yoke is being graspedby a robotic grasper.

FIG. 30 is an elevated perspective view, from the distal end, of theexemplary yoke mounted to a clip deployment device, where the view isdevoid of the draw wires and the clip release wires.

FIG. 31 is an underneath perspective view, from the distal end, of theexemplary yoke mounted to a clip deployment device, where the view isdevoid of the draw wires and the clip release wires.

FIG. 32 is an elevated perspective view, from the proximal end, of theexemplary clip deployment device and retention dowels, where the view isdevoid of the draw wires and the clip release wires.

FIG. 33 is an elevated perspective view, from the proximal end andlateral side, of the exemplary clevis, dual pivot joint, and yokemounted to a clip deployment device and an occlusion clip, where thedraw wires and the clip release wires are shown.

FIG. 34 is an elevated perspective view, from the proximal end andlateral side, of the exemplary clevis, dual pivot joint, and yokemounted to a clip deployment device and an occlusion clip, where thedraw wires, the clip release wires, and the suture loops are shown.

FIG. 35 is a magnified elevated perspective view showing the attachmentbetween the occlusion clip and the clip deployment device, as well asthe interaction of the draw wires and the clip release wires.

FIG. 36 is a perspective view of an exemplary clamp in an open positionthat may be used with the exemplary laparoscopic device of FIG. 1.

FIG. 37 is a perspective view of the exemplary clamp of FIG. 36 in aclosed position.

FIG. 38 is a cross-sectional view of the exemplary clamp of FIG. 36 inits open configuration, showing the wire member, rigid tubular members,and the urging members.

FIG. 39 is a cross-sectional view of the exemplary clamp of FIG. 37 inits closed configuration, showing the wire member, rigid tubularmembers, and the urging members.

FIG. 40 is a perspective view of the exemplary claims of FIGS. 36-39 andshowing the ability to close in a non-parallel fashion.

FIG. 41 is a perspective view of the first stage of assembly of analternate embodiment of a clamp, showing a wire member surrounded byrigid tubular members.

FIG. 42 is a perspective view of the second stage of assembly of theclamp of FIG. 41, in which platens have been added over the rigidtubular members.

FIG. 43 is a perspective view of the clamp of FIGS. 41 and 42, once anouter fabric covering has been disposed over the entire surface of theclamp.

DETAILED DESCRIPTION

The exemplary embodiments of the present disclosure are described andillustrated below to encompass surgical equipment and, morespecifically, to surgical equipment that may be used in minimallyinvasive procedures. The disclosure also relates to surgical equipmentto facilitate the positioning and deployment of an atrial appendageocclusion device. In addition, the disclosure relates to surgicalequipment that is adapted to accommodate or work in tandem with flexibleendoscopes. Of course, it will be apparent to those of ordinary skill inthe art that the embodiments discussed below are exemplary in nature andmay be reconfigured without departing from the scope and spirit of thepresent disclosure. However, for clarity and precision, the exemplaryembodiments as discussed below may include optional steps, methods, andfeatures that one of ordinary skill should recognize as not being arequisite to fall within the scope of the present disclosure.

Referring to FIG. 1, an exemplary clip deployment apparatus 100comprises a controller 110 mounted to a proximal portion of a rigid orsemi-rigid conduit 112 that is relatively linear. The controller 110includes various controls in order to manipulate a repositionablemechanism operatively coupled to an end effector 118, where therepositionable mechanism is mounted to a distal portion of the conduit112. In this exemplary embodiment, the repositionable mechanism iscoupled to an end effector comprising a clip deployment device 118. Butas will be discussed in more detail hereafter, the end effector 118 maycomprise any number of devices such as, without limitation, forceps,ablation rails, jaws, linear cutters, ablation pens, ablation clamps,illuminated dissectors, and non-illuminated dissectors.

The exemplary repositionable mechanism incorporates a dual passivemechanism. The first passive mechanism is operative to control the pitch(i.e., up and down) of the end effector 118, while the second passivemechanism is operative to control the yaw (i.e., side to side) of theend effector.

Referencing FIGS. 1-10, the controller 110 is coupled to the conduit 112in order to manipulate a repositionable mechanism operatively coupled tothe end effector 118. The controller 110 comprises a right side housing130 and a left side housing 132 that cooperatively define an internalcavity and corresponding openings to accommodate throughput of certaincontrols. A first of these openings is a dorsal opening 134 thataccommodates throughput of a repositionable button 136. As will bediscussed in more detail hereafter, the repositionable button 136 may bemanipulated vertically to lock and unlock the repositionable mechanisms,as well as forward-to-rearward to lock and unlock the position of thebutton itself, in order to provide for or constrain lateral and verticaladjustability of the end effector 118.

The repositionable button 136 comprises a proximal-to-distal arcuate top138 that includes bumps and a proximal ridge to accommodate the thumb ofa user being positioned on top of the button. The medial-to-lateralwidth of the arcuate top 138 is generally constant and overlaps avertical, planar appendage 142 that extends from the underside of thearcuate top. This vertical appendage 142 has a relatively constant andminimal medial-to-lateral dimension, but includes a proximal-to-lateraldimension that tapers from a maximum where the appendage extends fromthe arcuate top, to a minimum where the appendage ends. Extendingthrough this vertical appendage 142 is a U-shaped through hole 144 thatis partially occupied by an axle 164. This U-shaped through hole 144allows the button 136 to be vertically repositioned with respect to theaxle 164 so that active pressure is required to maintain a depressedbutton position when the axle is in a distal portion of the throughhole. Instead of having to maintain pressure upon the button 136 tosustain it in a depressed position, the user may choose to rotate thebutton with respect to the axle 164 in order to seat the axle in aproximal portion of the through hole 144, thus effectively locking thebutton in the depressed position. In order to unlock the button 136, auser simply rotates or pushes the button proximally to cause the axle164 into the distal portion of the through hole 144.

At the end of the appendage 142, a pair of tooth receivers 146 extendoutward in the medial and lateral directions from opposing sides of theappendage. The tooth receivers 146 each include a series of longitudinalpyramidal shapes 148 that are in parallel and radially arranged in orderto define a series of corresponding longitudinal pyramidal cavities 150.At the medial end of the medial tooth receiver 146 and at the lateralend of the lateral tooth receiver 146 is a cylindrical projection 152that is received within corresponding vertical, oblong grooves 154 onthe interior of the housings 130, 132. These grooves 154 inhibitsignificant medial-to-lateral and proximal-to-distal travel of the toothreceivers 146 as the tooth receivers are vertically repositioned. Inother words, as the button 136 is depressed vertically, the toothedreceivers 146 are vertically repositioned in a corresponding verticalmanner. In this way, the movement of the toothed receivers 146 isdirectly attributable to the movement of the button 136 as the toothedreceivers are indirectly mounted to the button via the appendage 142.

The button 136 is biased vertically to its highest vertical positionshown in FIG. 6. To achieve this bias, the housings 130, 132 includeparallel walls 158 that cooperate to form medial-to-lateral trenchwithin which at least one spring 160 is seated. The spring 160 is ratedat a sufficient spring force to overcome the weight of the button 136,appendage 142, tooth receivers 146, and cylindrical projections 152 toforce the button to its highest vertical position. But the spring forceis not so great that it requires too great a force from a user's thumbto depress the button 136 and overcome the bias of the spring 160.

An axle 164 extends in the medial-to-lateral direction within theinterior cavity cooperatively defined by the housings 130, 132. Thisaxle 164 is cylindrical in shape and includes a constant longitudinaldiameter, thereby giving the axle a circular circumference. In exemplaryform, the medial and lateral ends of the axle 164 are received withincorresponding cylindrical cavities (not shown) on the interior of thehousings. The depth of these cavities is not so great as to cover themajority of the axle 164. The exposed cylindrical portion of the axle164 is operative to receive a pair of toothed assemblies 168, 170 thatare interposed by the appendage 142, which itself includes a vertical,oblong orifice (not shown) to accommodate throughput of the axle andvertical travel of the appendage with respect to the axle, which has afixed orientation. In exemplary form, the toothed assemblies 168, 170include a through cylindrical orifice 172 allowing the assemblies torotate on the outside of the axle.

Each of the toothed assemblies 168, 170 are identical to each other.Accordingly, a redundant description of the second toothed assembly hasbeen omitted in furtherance of brevity. The toothed assemblies 168, 170include a wheel 176 having circumferentially distributed teeth 178 thatare sized to engage a respective tooth receivers 146 and be receivedwithin the longitudinal pyramidal cavities 150 when the tooth receiversin a raised vertical position (see FIG. 6). In exemplary form, thespring rate of the spring 160 is chosen to allow the tooth receivers 146to be depressed by forces applied to the toothed assemblies 168, 170above a predetermined threshold. For example, a high load applied to theend effector in any one direction may result in repositioning of one orboth of the toothed assemblies 168, 170, thereby causing a wheel 176 andits teeth 178 to rotate and correspondingly depress against thecorresponding tooth receiver 146, which depresses against the spring 160to compress the spring, thus allowing one or both wheels to rotate toavoid breaking any of the components.

The wheel 176 has a generally uniform width but for a pair of outgrowths180, 182. The first outgrowth 180 is generally centered radially withrespect to the wheel and partially defines the through orifice 172 thatreceives the axle 164. This first outgrowth 180 is semicircular in shapeextends medially from the wheel 176 and includes a corresponding top andbottom arcuate surfaces 184, 186 that are radially inset with respect tothe wheel. These arcuate surfaces 184, 186 act as camming surfaces forrespective connection wires 188, 190 that extend from the secondoutgrowth 182. The first outgrowth 180 also includes a pair of verticalflanges 194 that extend from the arcuate surfaces 184, 186 and cooperatewith the circumferential ends of the wheels in order to provide medialand lateral guides for the connection wires 188, 190 so that theconnection wires stay therebetween. The second outgrowth 182 isproximally oriented with respect to the first outgrowth 180 and includesa rectangular profile with a pair of L-shaped walls 192 and floor 196cooperating to define an internal cavity. An opening (not shown) extendsthrough the floor and into the cavity. This opening receives a fastener(such as a screw) 200 around which the connection wires 188, 190 arewound and secured in place. The fastener 200 is also recessed within thecavity so that the L-shaped walls 192 extend laterally beyond the end ofthe fastener. Accordingly, the connection wires 188, 190 extending fromthe fastener are threaded through a gap between the L-shaped walls 192,with one of the wires being threaded over the top arcuate surface 184,while the second wire is threaded under the bottom arcuate surface 186.Thereafter, the wires 188, 190 extend distally and taper to extendthrough a respective eyelet opening at the proximal end of the conduit112.

Each of the toothed assemblies 168, 170 is independently rotatablyrepositionable with respect to one another. The first toothed assembly168 is operative provide part of a passive repositionable mechanism inorder to control the pitch (i.e., up and down) of the end effector 118,while the second toothed assembly 170 is operative to provide part of apassive repositionable mechanism in order to control the yaw (i.e., sideto side) of the end effector. In exemplary form, when the button 136 isnot depressed, the spring 160 is operative to bias the toothed receivers146 into engagement with the teeth 178 of the toothed assemblies 168,170, thereby inhibiting rotation of the toothed assemblies around theaxle 164. When the tooth assemblies 168, 170 are locked in position (seeFIG. 6) the end effector 118 cannot be repositioned in the verticaldirection (i.e., affecting pitch) or in the medial-to-lateral direction(i.e., affecting yaw). Thus, when the tooth assemblies 168, 170 arelocked in position (see FIG. 6), so too is the end effector 118 lockedin position.

In order to change the vertical or medial-to-lateral position of the endeffector 118, a user would depress the button 136. By depressing thebutton 136, the toothed receivers 146 are operative to further compressthe spring 160 and disengage the toothed assemblies 168, 170. Morespecifically, the longitudinal pyramidal shapes 148 and correspondinglongitudinal pyramidal cavities 150 no longer engage the teeth 178 ofthe toothed assemblies 168, 170, thereby allowing rotation of thetoothed assemblies around the axle 164. By allowing free rotation of thetoothed assemblies 168, 170 around the axle 164, the connection wires188, 190 linking the end effector 118 and the toothed assemblies may berepositioned, which allows the end effector to be freely repositionablein the vertical direction (i.e., affecting pitch) and in themedial-to-lateral direction (i.e., affecting yaw). After the respectivevertical and medial-to-lateral position of the end effector 118 has beenreached, the user would discontinue depressing the button 136 to lock inthe relative vertical and medial-to-lateral positions. In order to lockin the positions, the spring 160 forces the toothed receivers 146 upwardand into engagement with the toothed assemblies 168, 170. Because thetoothed assemblies 168, 170 include teeth 178 that engage thelongitudinal pyramidal shapes 148 of the toothed receivers 146, thespring 160 will direct the toothed receivers upward and cause thetoothed assemblies to possibly rotate slightly about the axle 164 sothat the teeth are fully received within the longitudinal pyramidalcavities 150. If the position of the end effector 118 is such that theteeth 178 are aligned with the longitudinal pyramidal cavities 150, thenthe vertical and medial-to-lateral positions will be preciselymaintained because of the tension on the connection wires 188, 190. Butif the position of the end effector 118 is such that the teeth 178 areslightly misaligned with the longitudinal pyramidal cavities 150, thenthe vertical and medial-to-lateral positions will be changed as thetoothed assemblies 168, 170 rotate slightly about the axle 164 so thatthe teeth are fully received within the longitudinal pyramidal cavities150. After the teeth 178 are aligned and received within thelongitudinal pyramidal cavities 150, the vertical and medial-to-lateralpositions will be precisely maintained because of the tension on theconnection wires 188, 190.

In order to maintain the orientation of the semi-rigid conduit (whichcarries the connection wires 188, 190) with respect to the housings 130,132, a distal portion of the right side housing 130 includes a pair ofdetents 202 that engage the conduit 112. These detents 202 inhibitlongitudinal movement of the conduit 112 with respect to the controller110. Both detents 202 extend in parallel to one another and extend froman interior circumferential surface of the right side housing 130.

The right and left side housings 130, 132 cooperate to delineate ahandle mechanism port 210 and a proximal port 212 open to the interiorsof the respective housings. The handle mechanism port 210 accommodatesthroughput of a portion of a handle mechanism 218 that comprises arepositionable lever 220, a drive plate 222, a return spring 224, and awire retainer 226. As will be discussed in more detail hereafter, thewire retainer 226 is concurrently coupled to draw wires 228 and thedrive plate 222 so that movement of the lever 220 is operative to openand close an occlusion clip 1160 (compare FIGS. 29 and 34), such asduring an atrial appendage occlusion clip deployment surgical procedure.A more detailed explanation of the respective components of the handlemechanism 218 follows.

The repositionable lever 220 includes an arcuate, ventral grippingsurface that may include a series of convex bumps longitudinally spacedapart to facilitate gripping by a user. Opposite the ventral grippingsurface is a corresponding interior surface from which a pair of spacedapart, parallel vertical walls 230, 232 extend. The vertical walls 230,232 are also connected to one another via a plurality of cross walls234. The vertical walls 230, 232 each include a distal upstanding loop238 that provides a through opening in the medial-to-lateral directionto receive a axle 240 extending from the right side housing 130 aroundwhich the lever 220 rotates. Extending distally from the loop 238, thewalls 230, 232 include a circular opening extending in themedial-to-lateral direction that receives a pin 244 in order torepositionably mount the drive plate 222 to the lever 220.

The exemplary drive plate 222 comprises an arcuate, flat plate sized tofit between the walls 230, 232 of the lever 220. A distal end of theplate 222 includes an opening to receive the pin 244. Extendingproximally from the opening is an elongated, arcuate opening 246 adaptedto receive a dowel 248 extending from the interior of the right sidehousing 130. In this manner, the dowel 248 is repositioned with respectto the opening 246 as the lever 220 repositions the drive plate 222. Inexemplary form, the opening is partially defined by a lip 250 that actsto retain the dowel 248 in a static position after the lever 220 isfully closed. At the same time, the proximal end of the drive plate 222includes an orifice 252 that receives a portion of the spring 224 inorder to bias the lever 220 to the open position shown in FIG. 3. Theopposing end of the spring 224 is mounted to a dowel 254 that extendsfrom the interior of the right side housing 220.

The controller 110 also includes a removable stem 260 that is seatedwithin the proximal port 212 of the housings 130, 132. The removablestem 260 is coupled to one or more clip release wires 292 (in this case,two clip release wires) that act to disconnect an occlusion clip fromthe clip deployment device 118. In this manner, the stem 260 may beremoved from the proximal end of the controller 110, thereby drawing therelease wire(s) proximally and disconnecting the occlusion clip from theclip deployment device 118. In this exemplary embodiment, the stem 260is secured within the proximal port 212 via a friction fit that may beovercome by the user applying pressure to the stem to move it proximallywith respect to the controller 110. But it is also within the scope ofthe disclosure to use detents or other affirmative release mechanisms torelease the stem 260 from the controller 110.

The controller 110 is mounted to a rigid or semi-rigid conduit 112 thatis relatively linear and has a relatively constant circular crosssection. In this exemplary embodiment, the conduit 112 is fabricatedfrom stainless steel and includes a proximal circular opening and adistal circular opening. The proximal circular opening provides accessbetween the interior of the conduit 112 and the interior of thecontroller 110. More specifically, the hollow interior of the conduit112 accommodates throughput of the connection wires 188, 190 and theclip release wires 292. The conduit 112 includes a proximal sectionhaving a pair of rectangular, arcuate cut-outs providing respectiverecesses for the detents 202 of the right side housing 130 to occupy andmount the conduit 112 to the housings 130, 132.

In addition, the conduit 112 may be relatively linear but include twoadditional orifices that accommodate a separate conduit (not shown)adapted to provide a separate avenue for an exploratory tool. Exemplaryexploratory tools for use with the instant semi-rigid conduit include,without limitation, forceps, ablation rails, jaws, linear cutters,ablation pens, ablation clamps, illuminated dissectors, andnon-illuminated dissectors. The exemplary exploratory tool may be usedin combination with the end effector, which is manipulated by therepositionable mechanism.

Referring to FIGS. 11-14, a distal portion of the exemplaryrepositionable mechanism comprises a clevis 302 having a partiallyenclosed proximal section 304 that delineates a cavity 306 receives adistal section of the conduit 112 to mount the clevis to the conduit. Onthe interior of the cavity 306 are four equidistantly, radially spacedapart ribs 308 that extend longitudinally and in parallel to oneanother. The ribs 308 operate to decrease the diameter of the cavity 306so that the ribs contact the exterior, circumferential surface of theconduit 112 to mount the conduit to the clevis 302 via a friction fit.Each of the ribs 308 terminates distally at a wall 310 extending normalto the longitudinal direction of the ribs. The wall 310 includes aseries of orifices 312, 314, 316 that accommodate throughput of theconnection wires 188, 190 and the clip release wires 292. In exemplaryform, the first orifice 312 accommodates throughput of the firstconnection wire 188, while the second orifice 314 accommodatesthroughput of the clip release wires 292, while the third orifice 316accommodates throughput of the second connection wire 190. The wall 310also bridges the proximal section 304 and a distal section 320 of theclevis 302.

The distal section 320 of the clevis 302 includes a pair of distalprojections 324, 326 extending away from the wall 310 to create aceiling and floor. The projections 324, 326 are oriented to provide agap therebetween extending in proximal-to-distal direction and in amedial-to-lateral direction. Each projection 324, 326 includes a mildlyconvex outer surface 330 that is jointed by a peripheral surface 332that is rounded to at the distal tip. The peripheral surfaces 332 arejointed by respective exterior side surfaces 334. Each projection 324,326 includes a depression 336 that originates at the distal tip of theclevis 302 and extends proximally. The bounds of the depression 336 aredelineated by a planar bottom surface 340, a horseshoe (i.e.,semicircular) peripheral surface 342, and a planar base surface 344. Thearcuate contour of the peripheral surface 342 is operative to allow adual pivot joint to 350 to pivot in a single plane with respect to theclevis 302.

Referring to FIGS. 15-20, the dual pivot joint 350 comprises a proximalsection 352 having a pair of plateaus 354 that extend in oppositedirections from one another. Each plateau 354 includes a teardrop shapedcircumferential surface 356 with the rounded portion of the surfaceadapted to have an arcuate curvature that approximates the arcuatecurvature of the peripheral surface 342 of the clevis 302. The plateaus354 are interposed by a platform 358 having opposed, generally planarparallel surfaces 360. Accordingly, the dual pivot joint 350 may pivotwith respect to the clevis 302 by the plateaus 354 pivoting or rotatingwith respect to the peripheral surface 342, while the planar surfaces360 contact the planar base surfaces 344 of the clevis to limitsignificant vertical play between the clevis and dual pivot joint. Thepointed aspect of each circumferential surface 356 cooperates with thestraight walls of the peripheral surface 342 of the clevis 302 toprovide stops that limit the pivotal motion of the dual pivot joint 350with respect to the clevis 302 to no more than fifty-five degrees fromcenter (total range of motion of approximately 110 degrees). As will beunderstood by those skilled in the art, the range of travel may beincreased by increasing the angle of the pointed aspect of thecircumferential surfaces. Conversely, the range of travel may bedecreased by decreasing the angle of the pointed aspect of thecircumferential surfaces.

A proximal aspect of the platform 358 is rounded and includes two pairof arcuate walls 364 that are spaced apart from one another to create agap 368 that tapers distally to create a cylindrical through hole 376extending into the interior of a distal aspect 370 of the dual pivotjoint. The tapered feature of each gap 368 is partially defined by apair of angled faces 372 that operate to allow the connection wires 188to be fed in between the walls 364, through the cylindrical hole 376 andinto the interior of the distal aspect, where the wires are ultimatelyconnected to a yoke 380. The tapered nature of each gap 368 ensures thatthe connection wires 188 do not become bound up by pivoting action ofthe dual pivot joint 350 with respect to the clevis 302. But for thetapered nature of the gap 368, pivoting action beyond center of the dualpivot joint 350 with respect to the clevis 302 would cause the path ofthe connection wires 188 to be lengthened, thereby resulting in pivotingof the yoke 380 with respect to the dual pivot joint.

Interposing the two pair of arcuate walls 364 and respective gaps 368 isa centered gap 384 that also tapers distally to create a through hole386 having a rectangular, rounded cross-section that extends into theinterior of the distal aspect 370 of the dual pivot joint. The taperedfeature of this centered gap 384 is partially defined by a pair ofangled faces 388 that operate to allow the draw wire 228 and cliprelease wires 292 to be fed in between the walls 364, through the hole386, and into the interior of the distal aspect, where the wires areultimately fed through a clip deployment frame 520. The tapered natureof this gap 384 ensures that the draw wire 228 and clip release wires292 do not become bound up by pivoting action of the dual pivot joint350 with respect to the clevis 302. But for the tapered nature of thegap 384, pivoting action beyond center of the dual pivot joint 350 withrespect to the clevis 302 would cause the path of the draw wire 228 andclip release wires 292 to be lengthened, thereby potentially resultingin premature release of the clip 1160 and opening of the clip.

Adjoining the angled faces 388 is an arcuate wall 390 that curves arounda lateral edge of the proximal section 352 and extends into the interiorof the distal section 370. The arcuate wall 390 is inset within theproximal section 352 to create a lateral trench 392 on the right andleft sides. Each lateral trench 392 ends distally proximate a lateral,longitudinal opening 396 extending through right and left side paddles402. This pair of lateral trenches 390 respectively receives one of theconnection wires 190 so that the ends of each connection wire extendinto the interior of the distal section 370. Each end of the connectionwire 190 is enlarged to prohibit the end from passing through thelongitudinal opening 396. In other words, the longitudinal opening 396is sized to allow throughput of the connection wire 190 along thelongitudinal length of the connection wire, but is sized to prohibitthroughput of the enlarged end of the connection wire. In this manner,tension can be applied the connection wires 190 in order to cause thedual pivot joint 350 to pivot with respect to the clevis 302. Byapplying tension to the right side connection wire 190, the dual pivotjoint pivots to the right side. Conversely, by applying tension to theleft side connection wire 190, the dual pivot joint pivots to the leftside.

The right side paddle 402 is a mirror image of the left side paddle.Accordingly, for purposes of explanation, only a single paddle will bedescribed. Each paddle 402 includes a lateral exterior surface 406 thatis substantially planar but for a pair of projections 408 that arespaced apart from one another by the longitudinal opening 396 extendingtherebetween. Each projection 408 includes a linear aspect 410 thatextends in parallel with the longitudinal opening 396 and a curvedaspect 412. As will be discussed in more detail hereafter, the curvedaspect 412 has a curvature that mirrors the arcuate motion of the yoke380. The paddle 402 includes a vertical height extending above and belowthe proximal section 352. The top and bottom surfaces 414 of the paddle402 are generally planar and are bridged by a curved circumferentialsurface 418. The lateral or widthwise dimension of the paddle 402 issubstantially uniform, from proximal to distal, but for an interiordepression 420 that is open on the distal end of the paddle and extendsproximally to intersect the longitudinal opening 396. The depression 420is partially defined by a planar wall 424 that is perpendicular to asecond planar wall 426 with an arcuate transition therebetween. At thesame time, a third wall 428 is also perpendicular to the planar wall 424and includes an arcuate profile that corresponds to the arcuate profileof a plateau of the yoke 380. An interior planar wall 430 of each paddle402 intersects a pair of rectangular projections 432. Each rectangularprojection 432 includes a distal wall 436 that is arcuate from right toleft. The arcuate curvature of the distal wall generally tracks thearcuate profile of a portion of the yoke 380.

Referring to FIGS. 21-26, the yoke 380 comprises a hollow box having aroof 440, a floor, 442, a right side wall 444, and a left side wall 446.The front of the box is open and reveals the interior cavity. Extendinglaterally outward from the right and left side walls 444, 446 arerespective right and left wings 448, 450.

Each wing 448, 450 includes a pair of circumferential projections 452that extend vertically therethrough to protrude above and below thewing. In this exemplary embodiment, the projections are sized and spacedapart to facilitate grasping of the yoke 380 by a robotic grasper 456(see FIG. 29). A distal portion of the each wing 448, 450 is generallyflush with walls defining a distal recess 458 within the respectiveright and right and left side walls 444, 446. As will be discussed inmore detail hereafter, the distal recess is sized to accommodate partialinsertion of the clip deployment frame 520.

The right wing 448 is laterally widest at its distal end and tapers in awidthwise dimension, bounded by an arcuate peripheral surface 460. Theproximal portion of the right wing 448 extends proximally beyond thehollow box and includes a planar guide 464 that is parallel to a rightside plateau 466 extending from a proximal section 468 of the yoke 380.A hole 470 extends through the planar guide 464 and extends intocommunication with an underneath trench 472 formed into the bottomsurface 474 of the right wing. This underneath trench 472 terminatesdistally at the distal end of the right wing 448. In particular, one ofthe clip deployment wires 292 is fed past the proximal section 468,through the hole 470, and along this underneath trench 472 to exit andextend distally from the trench.

The proximal section 468 includes right and left side plateaus 466, 476that extend in opposite directions from one another. Each plateau 466,476 includes a teardrop shaped circumferential surface 478 with therounded portion of the surface adapted to have an arcuate curvature thatapproximates the arcuate curvature of the third wall 428 of the dualpivot joint 350. The plateaus 466, 476 are interposed by a platform 482having opposed, generally planar parallel surfaces 484. Accordingly, theyoke 380 may pivot with respect to the dual pivot joint 350 by theplateaus 466, 476 pivoting or rotating with respect to the third wall428. The pointed aspect of each circumferential surface 478 cooperateswith the straight walls of the second planar wall 426 of the dual pivotjoint 350 to provide stops that limit the pivotal motion of the dualpivot joint with respect to the yoke to no more than fifty-five degreesfrom center (total range of motion of approximately 110 degrees). Aswill be understood by those skilled in the art, the range of travel maybe increased by increasing the angle of the pointed aspect of thecircumferential surfaces. Conversely, the range of travel may bedecreased by decreasing the angle of the pointed aspect of thecircumferential surfaces.

A proximal aspect of the platform 482 is rounded and includes two pairof arcuate, solid walls 486 that are spaced apart from one another tocreate a gap 488 that tapers distally to create a through hole 490extending into the interior of the hollow box. The tapered feature ofthis gap 488 is partially defined by a pair of angled faces that operateto allow the draw wires 228 to be fed in between the walls 486, throughthe hole 490 and fed through the clip deployment frame 520, where thewires are ultimately connected to an occlusion clip 1160 (see FIG. 30).The tapered nature of this gap 488 ensures that the draw wires 228 donot become bound up by pivoting action of the yoke 380 with respect tothe dual pivot joint 350. But for the tapered nature of the gap 488,pivoting action beyond center of the yoke 380 with respect to the dualpivot joint 350 would cause the path of the draw wires 228 to belengthened, thereby resulting in potentially premature opening of theocclusion clip 1160.

Interposing the solid walls 486 and inset therein are top and bottomarcuate walls 492, 494. The arcuate nature of these walls 492, 494,teamed with being inset in between the solid walls 486 creates a groovethat feeds respective top and bottom holes 498, 500 that are open to theinterior of the hollow box. In exemplary form, each connection wire 188is received within the respective grooves so that the distal ends of theconnection wires extend into the interior of the hollow box. Each end ofthe connection wires 188 is enlarged to prohibit the end from passingthrough the top and bottom holes 498, 500. In other words, the holes498, 500 are sized to allow throughput of the connection wires 188, butare sized to prohibit throughput of the enlarged end of the connectionwires. In this manner, tension can be applied the connection wires 188in order to cause the yoke 380 to pivot with respect to the dual pivotjoint 350. By applying tension to the top side connection wire 188, theyoke pivots upward with respect to the dual pivot joint 350. Conversely,by applying tension to the bottom connection wire 188, the yoke pivotsdownward with respect to the dual pivot joint 350.

Adjacent the platform 482, on the left side, is the left wing 450. Theleft wing 450 is laterally widest at its distal end and tapers in awidthwise dimension, bounded by an arcuate peripheral surface 504. Theproximal portion of the left wing 450 extends proximally beyond thehollow box and includes a planar guide 506 that is parallel to the leftside plateau 476. A hole 508 extends through the planar guide 506 andextends into communication with an underneath trench 510 formed into thebottom surface 512 of the left wing. This underneath trench 510terminates prior to reaching the distal end of the left wing 450. Inparticular, the trench 510 terminates and feeds into a distal tunnel 514that extends through a distal portion of the left wing 450. In thisexemplary embodiment, a second of the clip deployment wires 292 is fedpast the proximal section 468, through the hole 508, along thisunderneath trench 510, through the tunnel 514 and exits distally fromthe tunnel.

Referring to FIGS. 27-35, the clip deployment device 118 is partiallyreceived within the interior of the hollow box. In exemplary form, theclip deployment device 118 includes a rectangular frame 520 havingparallel longitudinal sides 524, 526 that are connected to one anothervia a distal cross-member 527 with rounded corners therebetween. In thisexemplary embodiment, each parallel side 524, 526 includes asubstantially planar interior wall 528 and a concave exterior wall 530,opposite the interior wall. The concave nature of the exterior wall 530creates a longitudinal channel, with one exterior channel receiving afirst of the clip deployment wires 292. In addition, the parallel sides524, 526 may include one or more through orifices extending through theinterior and exterior walls 528, 530.

The proximal end of the rectangular frame 522 includes a pair of roundedcorners that extend from the parallel sides 524, 526. Each roundedcorner on the proximal end forms part of an S-shaped retainer 540, 542that is partially received within the hollow box interior of the yoke380. More specifically, both S-shaped retainers 540, 542 comprise afirst rounded corner that transitions into a straight segment 546, whichtransitions into a semicircular segment 548. The S-shaped retainers 540,542 are mirror images of one another, except that the one retainer 540includes an orifice 550 that extends through the interior and exteriorsurfaces and along the majority of the straight and semicircularsegments 546, 548.

In order to secure the clip deployment device 118 to the yoke 380, twodowels 560 are inserted through corresponding holes 562 in the top andbottom surfaces 440, 442 of the yoke. The holes 562 are sized to retainthe dowels 560 in position. But before the dowels 560 are inserted intothe holes 562, the S-shaped retainers 540, 542 are inserted into theinterior of the yoke 380. In exemplary form, the vertical dimension ofthe S-shaped retainers 540, 542 is such that the retainers are wedged inbetween the top and bottom walls 440, 442 of the yoke 380. Moreover, thecollective lengthwise dimension of the S-shaped retainers 540, 542 issuch that the retainers are wedged in between the right and left sidewalls 444, 446. In this manner, even absent the dowels 560, there is notsignificant play between the clip deployment device 118 to the yoke 380in the vertical and lateral directions. In order to reduce play in theproximal-to-distal direction, the dowels 560 are inserted through theholes 562 after the semicircular segment 548 of each S-shaped retainers540, 542 is positioned to partially outline an imaginary cylinderextending through the holes. This locks the S-shaped retainers 540, 542in position with respect to the yoke 380, thereby mounting the clipdeployment device 118 to the yoke.

The orifice 550 of the one retainer 540 provides an egress hole throughwhich a second of the clip deployment wires 292 passes through. Thesecond of the clip deployment wires 292 extends into the interior of therectangular frame 522 and passes longitudinally along the exterior of anelongated deployment plate 566. The deployment plate 566 includes a pairof orifices 568 near the proximal and distal ends of the plate. As willbe discussed in more detail hereafter, the orifices 568 receive sutureloops 570 that are captured by the clip deployment wire 292 passingtherethrough.

The orifice 550 also provides an egress hole through which the drawwires 228 pass through. The draw wires 228 are initially routed into theinterior of the rectangular frame 522 to pass through an orifice 572 inone of the proximal rounded corners. Both wires 228 extend along thelongitudinal channel of one of the parallel sides 524 created by theconcave exterior wall 530. One of the wires passes through a firstproximal orifice 576 in the first parallel side 524, while the secondwire continues to extend along the longitudinal channel until reaching asecond distal orifice 578. Both wires 228 then extend into the interiorof the rectangular frame 522 and pass perpendicularly through a secondset of orifices 580 of the elongated deployment plate 566. This secondset of orifices 580 are inset with respect to the pair of orifices 568near the proximal and distal ends of the plate. The wires are joined andcreate a closed loop coupled to the deployment plate 566.

Referring to FIGS. 36-38 show one embodiment of a left atrial appendageocclusion clamp 1110 in an open position with spaced apart rigidclamping portions 1102, 1104 and resilient or elastic urging members1106, 1108 at opposite ends of each clamping portion 1102, 1104.Clamping portions 1102, 1104 may be tubular, and both clamping portions1102, 1104 may be at least substantially parallel to each other whenarrest, i.e., when they are not being used to clamp tissue. Clampingportions 1102, 1104 may also be of substantially equal length or ofdifferent length, and each may be of larger outer diameter than the wirethat may be used to form each of the urging members 1106, 1108. In thisregard, the wire forming urging members 1106, 1108 can extend throughthe hollow interiors of the clamping portions 1102, 1104. In thisillustrative example, the urging members 1106, 1108 are each shaped as aloop. The planes defined by the looped configuration of each of theurging members 1106, 1108 may be substantially parallel to each otherand, in turn, substantially perpendicular to each of the clampingportions 1102, 1104. Of course, other angular orientations are possibleas well.

FIGS. 37-39 show the same clamp 1110 of FIGS. 36-38 with the clampingportions 1102, 1104 in their normally biased together positions. Contactbetween the clamping portions 1102, 1104 may occur initially along theirentire parallel lengths as shown. Of course, when clamping portions1102, 1104 are covered in fabric or other material as later described,contact may occur between the fabric or other material instead. In FIGS.36-39, only the structure and relative positions of the rigid members1102, 1104 and urging members 1106, 1108 are shown. The final assemblyis depicted in FIGS. 40-42 which, although describing a slightlydifferent embodiment, show the general steps in the construction of eachembodiment. The clamping portions 1102, 1104 may be made from rigidtubes 1112, 1114 of a rigid metal such as titanium disposed over a wiremember 1116. In this embodiment, titanium is used for its compatibilitywith MRI imaging, its biocompatibility and its galvanic compatibilitywith the wire member 1116 when the wire member 1116 is formed fromsuperelastic materials such as a nickel titanium alloy. This embodimentand the other embodiments disclosed herein may use a superelasticmaterial such as a nickel titanium alloy to form the urging members1106, 1108. Superelastic properties will allow the material to begreatly extended to open the clamping portions 1106, 1108 of the clamp1110 without permanently deforming the material. These superelasticmaterials can also be compatible with MRI imaging and easily toleratedas an implant material in the body. The rigid tubular members 1112, 1114of this embodiment are mechanically fastened to the underlying wiremember 1116 preferably by mechanically swaging the titanium tubes 1112,1114 to the wire members 1116. Although a single, continuous wire memberis shown directed through both clamping portions 1102, 1104 and urgingmembers 1106, 1108, the clamp 1110 of this embodiment may also be madewith two or more wires, or with any other suitable components.

As shown in FIG. 40, in addition to being able to close on tissue oranatomical structure in a parallel fashion, the clamp 1110 can alsoapply force to the anatomical structure in a nonparallel clampingfashion. This allows the clamp 1110 to accommodate non-uniform tissuethickness over the length of the clamping portions 1102, 1104. Inaddition, with separate urging members 1106, 1108 at opposite ends ofthe clamping portions 1102, 1104 the nonparallel clamping can originatefrom either side of the clamp 1110. The non-parallel clamping feature ofthis embodiment allows the clamp 1110 to accommodate a wide range ofhollow anatomical structures with varying wall thicknesses throughoutits length and breadth. For example, some anatomical structures such asatrial appendages of the heart have internal structures calledtrabeculae, which are non-uniform and very often cause variablethicknesses across one or more of their dimensions. Nonuniform clamping,therefore, can be advantageous in this application for this reason orfor other reasons.

FIG. 41 shows an alternate embodiment of a clamp 1160 including twourging members 1166, 1168 shaped to resemble a letter “U” instead of themore circular loop configuration of the embodiment of FIGS. 36-39. As isthe case with the first clamp 1110, the U-shaped urging members 1166,1168 of clamp 1160 may also lie in planes generally parallel to eachother and perpendicular to the axes of the clamping portions 1162, 1164.A potential use of the embodiment of FIG. 41 may lie in the lesser forceexerted by U-shape urging members 1166, 1168 on the clamping portions1162, 1164 with respect to the force exerted by the loop-shape urgingmembers 1106, 1108 of clamp 1110 in FIGS. 36-39, making it more suitablefor clamping of anatomical structures not requiring a relatively highclamping force. The U-shape configuration of the urging members 1166,1168 generally requires less space in the direction perpendicular to theaxes of the clamping portions 1162, 1164. FIG. 41 shows a first stage ofassembly of the clamp 1160, where the rigid tubular members 1163, 1165are joined with the superelastic wire member 1161. In this embodiment,mechanical swaging is used to join the tubular members 1163, 1165 to thewire 1161. However, adhesives or laser welding or other methods ofattachment could be easily used instead. Similarly, it will beappreciated that rigid tubular members 1163, 1165 may not necessarilyneed to be bonded to wire member 1161 at all. One may rely, for example,on designing the rigid tubular members 1163, 1165 so that their insidediameters simply closely fit over the wire 1161. In addition, the rigidtubular members 1163, 1165 could take on many different cross sectionalshapes. Cross-sectional shapes such as ovals, triangles or rectangleswith rounded edges could be preferable and may eliminate the addition ofthe load spreading platens 1167, 1169 shown in FIG. 42, as thesealternate shapes may provide a larger area of contact against theanatomical structure to be engaged by the clamp 1150. Since differentanatomical structures greatly vary from subject to subject, it isadvantageous to have a manufacturing method in which the length 1171 ofthe clamp 1160 can be easily varied. By cutting rigid members 1163, 1165to various different lengths, different size assemblies can beconfigured.

FIG. 42 shows the next step in the assembly of the clamp. Load spreadingplatens 1167, 1169 made of plastic or other biocompatible material suchas urethane, may be slipped over the titanium or other suitable materialtubing that forms rigid tubular members 1163, 1165, to provide aresilient surface 1173 to spread the load out onto a larger surfacearea, thereby preventing point source loading of the tissue which mightotherwise result in cutting of the tissue before it has had a chance tobecome internally fused. The platens 1167, 1169 can be assembled andapplied over the rigid tubular members 1163, 1165 prior to the swagingstep or platens 1167, 1169 can alternatively be manufactured in such away so as to have a longitudinal split which allows the material to beopened and forced onto the rigid tubular members 1163, 1165.

FIG. 43 shows the clamp 1160 after a fabric cover material 1174 made ofmaterial such as polyester has been sewn around the clamping portions1162, 1164 and urging members 1166, 1168. It will be appreciated thatthis material or any other similar materials may be used as a full orpartial covering in any of the disclosed embodiments. Such a material ispreferably suitable to engage the tissue of the anatomical structurebeing clamped as well as that of surrounding areas. Preferably, thematerial 1174 is circular warp knit fabric tube, with a diameter ofapproximately 4 to 5 mm and made from a combination of 4/100, 2/100 and1/100 textured polyester. The material 1174 may also be heat-treated tocause a velour effect. The fabric or other material 1174 is furthermoresewn or otherwise applied over the urging members 1166, 1168. Inaddition, fabric pieces 1177 may be attached at opposite respective endsof clamping portions 1162, 1164 to prevent any part of the engagedanatomical structure from escaping the annular occlusion area betweenthe clamping portions 1162, 1164. In other words, fabric pieces 1177 actas tissue blocking members or dams at opposite ends of the clamp. Thisor another tissue blocking feature may also be implemented into anyother embodiment. This is desirable as it minimizes the probability ofunintentionally leaving any part of the engaged anatomical structureunclamped. The material 1177, like material 1174, can also promotetissue in-growth.

Following from the above description and invention summaries, it shouldbe apparent to those of ordinary skill in the art that, while themethods and apparatuses herein described constitute exemplaryembodiments of the present invention, it is to be understood that theinventions contained herein are not limited to the above preciseembodiment and that changes may be made without departing from the scopeof the invention as defined by the following proposed points of novelty.Likewise, it is to be understood that it is not necessary to meet any orall of the identified advantages or objects of the invention disclosedherein in order to fall within the scope of the invention, sinceinherent and/or unforeseen advantages of the present invention may existeven though they may not have been explicitly discussed herein.

What is claimed is:
 1. A surgical device comprising: a housingoperatively coupled to a first control and a second control; an endeffector operatively coupled to the first control, the end effectorcomprising a first component and a second component selectivelyrepositionable with respect to one another as part of a first degree offreedom, the end effector also including a third component selectivelyrepositionable with respect to the second component as part of a seconddegree of freedom; a surgical conduit mounted to and extending betweenthe housing and the end effector; and, wherein the end effector includesan occlusion clip deployment device operatively coupled to the thirdcomponent and the second control, the occlusion clip deployment deviceincludes an enclosed frame delineating an opening, the enclosed framesized to circumscribe a left atrial appendage.
 2. The surgical device ofclaim 1, further comprising a left atrial appendage occlusion cliphaving opposing beams biased toward one another, the occlusion clipremovably mounted to the occlusion clip deployment device, wherein: thehousing is operatively coupled to a third control; the third control isoperatively coupled to the occlusion clip and the occlusion clipdeployment device; and, the third control governs removal of theocclusion clip from the occlusion clip deployment device.
 3. Thesurgical device of claim 1, wherein: the first control includes a firstpassive constraint and a second passive constraint; the first passiveconstraint in an unlocked position allows free motion between the firstcomponent and the second component within the first degree of freedom;the first passive constraint in a locked position retards free motionbetween the first component and the second component within the firstdegree of freedom; the second passive constraint in an unlocked positionallows free motion between the second component and the third componentwithin the second degree of freedom; and, the second passive constraintin a locked position retards free motion between the second componentand the third component within the second degree of freedom.
 4. Thesurgical device of claim 3, wherein: the first passive constraintincludes at least one connection line in tension that is operativelycoupled to the second component and to the housing; and, the secondpassive constraint includes at least one connection line in tension thatis operatively coupled to the third component and to the housing.
 5. Thesurgical device of claim 1, wherein: the first control includes arepositionable button selectively coupled to a first reel and a secondreel, where the button is repositionable between a locked and anunlocked position, where the locked position retards rotation of thefirst reel and the second reel, and where the unlocked position allowsrotation of the first reel and the second reel; the first reel isoperatively coupled to a first connection line operatively coupled tothe first component; the second reel is operatively coupled to a secondconnection line operatively coupled to the second component; and,wherein the first reel is independently repositionable with respect tothe second reel.
 6. The surgical device of claim 1, wherein: the secondcontrol includes a lever operatively coupled and selectivelyrepositionable with respect to the housing, the lever being operativelycoupled to a first connection line operatively coupled to the occlusionclip deployment device so that movement of the lever is operative toreposition at least a portion of the occlusion clip deployment device;the lever is repositionable between a locked and an unlocked position;the unlocked position allows the lever to be repositioned; and, thelocked position retards the lever from being repositioned.
 7. Thesurgical device of claim 1, further comprising a third controloperatively coupled to the housing, wherein the third control isoperatively coupled to a first connection line operatively coupled tothe occlusion clip deployment device so that movement of the thirdcontrol is operative to reposition at least a portion of the firstconnection line with respect to the occlusion clip deployment device. 8.The surgical device of claim 7, wherein: the third control includes aplug detachable from the housing; and, the plug is repositionable froman attached position coupled to the housing to a detached positiondecoupled from the housing; repositioning the plug from the attachedposition to the detached position causes more of the first connectionline to be drawn into a distal portion of the housing.
 9. The surgicaldevice of claim 8, further comprising an occlusion clip operativelycoupled to the clip deployment device using the first connection line.10. The surgical device of claim 1, wherein the end effector includes arobotic grasping feature to facilitate grasping and repositioning of theend effector by a robotic grasper.
 11. A surgical device comprising: ahousing operatively coupled to a first control; an end effectoroperatively coupled to the first control, the end effector comprising adual pivot joint providing a first degree of freedom within a firstplane and a second degree of freedom within a second plane, the secondplane being non-coplanar with the first plane; a surgical conduitoperatively coupled to and extending between the housing and the endeffector; wherein the end effector includes an occlusion clip deploymentdevice operatively coupled to the dual pivot joint, the occlusion clipdeployment device includes an enclosed frame delineating an opening, theenclosed frame sized to circumscribe a left atrial appendage.
 12. Thesurgical device of claim 11, wherein: the dual pivot joint isoperatively coupled to a clevis and a yoke; the first control includes afirst line and a second line extending along the surgical conduitconcurrently coupled to the dual pivot joint, the first line impactingmovement of the dual pivot joint with respect to the clevis within thefirst degree of freedom, the second line impacting movement of the dualpivot joint with respect to the clevis within the first degree offreedom; and, the first control includes a third line and a fourth lineextending along the surgical conduit concurrently coupled to the yoke,the third line impacting movement of the yoke with respect to the dualpivot joint within the second degree of freedom, the fourth lineimpacting movement of the yoke with respect to the dual pivot jointwithin the second degree of freedom.
 13. The surgical device of claim12, wherein: the first line and the second line are coupled to a firstactuator mounted to the housing; the first actuator is repositionableand operative to reposition the first line and the second line in orderto create movement between the clevis and dual pivot joint; the thirdline and the fourth line are coupled to a second actuator mounted to thehousing; the second actuator is repositionable and operative toreposition the third line and the fourth line in order to createmovement between the yoke and dual pivot joint.
 14. The surgical deviceof claim 13, wherein: the first actuator comprises a first reel uponwhich at least a portion of the first line and the second line arewound; the second actuator comprises a second reel upon which at least aportion of the third line and the fourth line are wound; repositioningof the first reel is operative to distally reposition one of the firstline and the second line, while repositioning of the first reel isoperative to proximally reposition the other of the first line and thesecond line; repositioning of the second reel is operative to distallyreposition one of the third line and the fourth line, whilerepositioning of the second reel is operative to proximally repositionthe other of the third line and the fourth line.
 15. The surgical deviceof claim 14, wherein the first control includes a brake that may beselectively applied to the first actuator and the second actuator toretard movement of the dual pivot joint with respect to the cleviswithin the X-Y plane and movement of the yoke with respect to the dualpivot joint within the Y-Z plane.
 16. The surgical device of claim 14,wherein: the brake comprises a spring biased button operatively coupledto a series of teeth; the first reel includes a series of teeth; thesecond red includes a series of teeth; and engagement between at leastone of the series of teeth operatively coupled to the spring biasedbutton and at least one of the series of teeth of the first reel andleast one of the series of teeth of the second reel is operative toretard movement of the dual pivot joint with respect to the cleviswithin the X-Y plane and movement of the yoke with respect to the dualpivot joint within the Y-Z plane.
 17. The surgical device of claim 11,further comprising a second control operatively coupled to the housing,wherein the second control includes a clip repositioning line extendingalong the surgical conduit, the dip repositioning line impactingmovement of the occlusion clip deployment device between a firstposition and a second position.
 18. The surgical device of claim 17,wherein: the second control includes a lever operatively coupled andselectively repositionable with respect to the housing, the lever beingoperatively coupled to the clip repositioning line so that movement ofthe lever is operative to reposition the occlusion clip deploymentdevice; the lever is repositionable between a locked and an unlockedposition; the unlocked position allows the lever to be repositioned;and, the locked position retards the lever from being repositioned. 19.The surgical device of claim 11, further comprising a deployment controloperatively coupled to the housing, the deployment control including adeployment line extending along the surgical conduit and concurrentlymounted to a deployment plug removably fastened to the housing.
 20. Thesurgical device of claim 19, further comprising an occlusion clipoperatively coupled to the occlusion clip deployment device using thedeployment line.
 21. The surgical device of claim 20, wherein: theocclusion clip includes a first jaw opposing a second jaw; a firstretainer loop at least partially circumscribes the first jaw, at least aportion of the occlusion clip deployment device, and at least a portionof the deployment line; a second retainer loop at least partiallycircumscribes the second jaw, at least a portion of the occlusion clipdeployment device, and at least a portion of the deployment line. 22.The surgical device of claim 11, wherein the end effector includes arobotic grasping feature to facilitate grasping and repositioning of theend effector by a robotic grasper.